The burden of hepatorenal syndrome among commercially insured and Medicare patients in the United States

Rice, J. Bradford; White, Alan G.; Galebach, Philip; Korenblat, Kevin; Wagh, Aneesha; Lovelace, Belinda; Wan, George J.; Jamil, Khurram

doi:10.1080/03007995.2017.1331211

Cited by 22 publications

(21 citation statements)

References 10 publications

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“…The costs of AC and non‐AC also approximate the range of per‐person yearly costs of cancer patients regardless of treatment (21,000‐90,000 US$ in commercially insured persons) . Our estimates of yearly costs of managing decompensated cirrhosis, hepatorenal syndrome, and HCC are similar to published cost estimates, supporting the robustness of our cost estimates . In studies of the global burden of AC, its disability‐adjusted life‐year burden exceeded that of other alcohol‐related malignancies .…”

Section: Discussionsupporting

confidence: 82%

The high burden of alcoholic cirrhosis in privately insured persons in the United States

et al. 2018

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Section: Discussionsupporting

confidence: 82%

The high burden of alcoholic cirrhosis in privately insured persons in the United States

et al. 2018

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“…Finally, the two studies differ in patient characteristics that may impact costs, including transplant rates. Whereas Rice et al 21 reported transplant rates of 10.7% for their commercial population and 1.6% for the Medicare population, our study population, from all payer sources, had a 2.1% transplant rate overall. The high cost of transplants and vastly different rates of transplants may be key differences in the observed costs.…”

Section: Discussioncontrasting

confidence: 57%

“…Previous studies have reported markers and assessments to estimate HRS resource utilization. However, drivers of total charges remain relatively unclear 21 . We created a generalized linear model to extend our initial findings to include characteristics that are statistically significant with respect to total visit charges for all patients, including length of stay, teaching hospital status, patients on dialysis, mortality, transfer to skilled nursing facility, or inpatient setting ( Supplementary Tables S3-S6).…”

Section: Discussionmentioning

confidence: 99%

“…A recent publication reported the substantial economic burden of HRS in the US using commercial claims and Medicare data, and identified notable differences in the mortality, transplant, and dialysis rates between Medicare populations and commercially-insured patients 21 . The current study sought to confirm and extend these analyses by examining the prevalence, outcomes, and costs associated with HRS in a large US hospital electronics health records (EHR) database, including patients from all potential payer types.…”

Section: Introductionmentioning

confidence: 99%

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The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records

Jamil

Huang

Lovelace

et al. 2019

Journal of Medical Economics

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Objectives: Hepatorenal Syndrome (HRS) is characterized by renal failure in patients with advanced chronic liver disease (CLD) and is the leading cause of hospitalizations in CLD. This study examines the clinical and economic burden, outcomes, and unmet need of HRS treatment in US hospitals. Method: A retrospective cohort study was conducted based on a large electronic health records database (Cerner HealthFacts) with records for hospitalized HRS patients from January 2009-June 2015. Demographics, clinical characteristics, treatment patterns, and economic outcomes were analyzed. Prognostic indicators of cirrhosis, kidney injury, end-stage liver disease, and acute-on-chronic liver failure were used to determine mortality risk. Results: A total of 2,542 patients hospitalized with HRS were identified (average age ¼ 57.9 years, 61.8% males, 74.2% Caucasian), with an average total hospital charge of $91,504 per patient and a mean length of stay (LOS) of 30.5 days. The mortality rate was 36.9% with 8.9% of patients discharged to hospice. Of all patients, 1,660 patients had acute kidney injury, 859 with Stage 3 disease, and 26.7% had dialysis. The 30-day readmission rate was 33.1%, 41% of which were unplanned. Nearly one-third of study patients had commercial insurance (30.2%), followed by Medicare (29.9%); hospital charges varied by LOS, receipt of dialysis, and discharge status. Regression analysis demonstrated that HRS costs are associated with LOS, dialysis, and hospital mortality. Conclusion: HRS is associated with poor outcomes and high hospital costs. Analysis of HRS cost drivers demonstrated an unmet need for additional treatment options to improve outcomes in this patient population.

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“…4 Another study described the prevalence of HRS in about 48% of patients listed for LT. 5 Apart from negative impact on patient survival and outcomes, HRS is associated with huge healthcare cost and significant socio-economic burden. 6 For example, in a retrospective study on 2542 patients hospitalized with HRS, mean length of hospital stay per patient was 30.5 days, with $91,504 per admission. 7…”

Section: Introductionmentioning

confidence: 99%

Management of Hepatorenal Syndrome: A Review

Tariq

Singal

2020

Journal of Clinical and Translational Hepatology

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Acute kidney injury (AKI) occurs frequently in patients with cirrhosis, and hepatorenal syndrome (HRS) is second most common etiology of AKI after volume responsible pre-renal etiology. AKI in these patients negatively impacts pre-and post-transplant patient survival and healthcare burden. Reduced effective blood volume with consequent reduced renal blood flow, along with systemic inflammation in patients with decompensated cirrhosis, result in susceptibility to HRS. In this article, we will review updates over the last 5 years on the changing definition with diagnostic criteria and nomenclature of AKI and HRS, data on medical treatment with vasoconstrictors, and urinary biomarkers in diagnosis of etiology of AKI. We will also discuss the significance of liver transplantation evaluation once the diagnosis of HRS is established and the post-transplant immunosuppression management. We will also review one of the challenging issues that remains among transplant-eligible patients, that of allocation of simultaneous liver kidney transplant. Finally, we will review the new implemented policy from the Organ Procurement Transplant Network on simultaneous liver kidney allocation.

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The burden of hepatorenal syndrome among commercially insured and Medicare patients in the United States

Abstract: HRS imposes a significant economic burden.

Cited by 22 publications

References 10 publications

The high burden of alcoholic cirrhosis in privately insured persons in the United States

The high burden of alcoholic cirrhosis in privately insured persons in the United States

The burden of illness of hepatorenal syndrome (HRS) in the United States: a retrospective analysis of electronic health records

Management of Hepatorenal Syndrome: A Review

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